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Predictors of early neurologic deterioration (END) following stroke thrombectomy
  1. Rohini Bhole1,
  2. Simonne S Nouer2,
  3. Elizabeth A Tolley2,
  4. Aquilla Turk3,
  5. Adnan H Siddiqui4,5,
  6. Andrei V Alexandrov6,
  7. Adam S Arthur7,8,
  8. J Mocco9
  9. for the COMPASS investigators
  1. 1Department of Neurology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
  2. 2Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
  3. 3Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
  4. 4Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  5. 5Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
  6. 6Neurology, UTHSC COM, Memphis, Tennessee, USA
  7. 7Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  8. 8Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  9. 9Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
  1. Correspondence to Dr Rohini Bhole, Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA; drrohinibhole{at}gmail.com

Abstract

Background Early neurologic deterioration (END) following ischemic stroke is a serious event and is associated with poor outcomes. However, the incidence and predictors of END after stroke thrombectomy for emergent large vessel occlusion are largely unknown.

Methods The baseline characteristics of patients enrolled in the COMPASS trial (NCT02466893) were analyzed. The primary outcome was worsening of ≥4 National Institutes of Health Stroke Scale (NIHSS) points 24 hours post thrombectomy (4+ END24) and the secondary outcome was deterioration of ≥2 points (2+ END24).

Results Among 270 patients, 27 (10%) developed 4+ END24 and 42 (16%) had 2+ END24. Those with 4+ END24 were older (76.4±12.9 vs 70.9±12.9 years; p=0.04), had a higher prevalence of hypertension (96% vs 69%; p=0.003), diabetes (41% vs 27%; p=0.13) and higher pretreatment systolic blood pressure (SBP) (170.4±32.6 vs 157.6±28.1 mmHg; p=0.03). More 4+ END24 patients had failed reperfusion: Thrombolysis in Cerebral Infarction ≤2a (26% vs 8%; p=0.003). In unadjusted analysis, older patients and those with hypertension, diabetes, elevated SBP and failed reperfusion had higher odds of 4+ END24. In adjusted analysis, age increase by 5 years led to an increase in 4+ END24 of 28%, diabetes increased odds of 2.6 and failed reperfusion increased odds of 4.5. In the multivariable analysis for the secondary outcome, age (OR 1.33; 95% CI 1.109 to 1.593), diabetes (OR 2.7; 95% CI 1.247 to 5.764) and failed reperfusion (OR 7.2; 95% CI 0.055 to 0.349) were also significant predictors of 2+ END24.

Conclusions Older patients with acute ischemic stroke who have a history of diabetes or hypertension, with elevated pretreatment SBP and failed reperfusion are at a higher risk of END following stroke thrombectomy for emergent large vessel occlusion.

  • Stroke
  • Thrombectomy

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @AdamArthurMD

  • Collaborators COMPASS group authors’ disclosures are included in the uploaded document titled " Supplemental Information for Editors only"

  • Contributors RB: study concept and design, wrote the statistical analysis plan, cleaned and analyzed the data, drafted and revised the paper and accepts full responsibilty for the work and the conduct of the study, had access to the data, and controlled the decision to publish.RB acts as the guarantor. SSN: study design, revised the statistical analysis and the draft paper. EAT: study design, revised the statistical analysis and the draft paper. AT: revised the draft paper. AHS: revised the draft paper. AVA: study design and revised the draft paper. ASA: study design and revised the draft paper. JM: provided dataset from original COMPASS trial, study design, drafted and revised the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.The initial COMPASS trial was funded by Penumbra; however, there was no additional funding for our study-related specific analysis.

  • Competing interests None

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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